An assessment of the survival impact of multimodal anesthesia/analgesia technique in adults undergoing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy: a propensity score matched analysis

• Published in: International journal of hyperthermia 2019-01, Vol.36 (1), p.368-374
• Main Authors: Cata, Juan P., Nguyen, Linh T., Ifeanyi-Pillette, Ifeyinwa C., Van Meter, Antoinette, Dangler, Lori A., Feng, Lei, Owusu-Agyemang, Pascal
• Format: Article
• Language: English
• Subjects: analgesics; Anesthesia - methods; Anesthesia - mortality; Anesthetics; cancer; Cytoreduction Surgical Procedures - methods; Cytoreduction Surgical Procedures - mortality; Female; Humans; Hyperthermia, Induced - methods; Hyperthermia, Induced - mortality; Male; Middle Aged; multimodal; Propensity Score; Retrospective Studies; survival
• ISSN: 0265-6736; 1464-5157
• DOI: 10.1080/02656736.2019.1574985

Background: Studies suggest volatile anesthetics and opioids may enhance the malignant potential of cancer cells. The objective of this single institution retrospective study was to evaluate the survival impact of a multimodal opioid-sparing nonvolatile anesthetic technique (MA) in a group of patients who had undergone cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) for appendiceal carcinomatosis. Methods: Propensity score matching (PSM) and Cox proportional hazard models were used to compare the survivals of patients who received MA (MA group), to those who received volatile-opioid anesthesia (volatile-opioid group). Results: Of the 373 patients, 110 (29%) were in the MA group and 263 (71%) in the volatile-opioid group. The MA group was older (mean ± standard deviation (SD): 55 ± 11 versus 53 ± 10 years, p = .035) and had more patients with ASA scores 3 or 4 (90% versus 81%, p = .032), and those with high grade tumors (18% versus 12%, p = .009). Intraoperative opioid consumption was lower in the MA group (mean morphine equivalents ± SD: 13 ± 10 versus 194 ± 789, p